Samsung Seoul Hospital Cancer Hospital Research Team
[Asia Economy Reporter Lee Gwan-joo] A study has found that even cancer patients diagnosed with the same disease face more fatal outcomes when under severe stress.
The research team led by Professors Kim Hee-cheol and Shin Jeong-kyung from the Colorectal Cancer Center at Samsung Seoul Hospital Cancer Center, Professor Jo Joo-hee from the Cancer Education Center, and Professor Kang Dan-bi from the Clinical Epidemiology Research Center announced on the 21st that higher 'distress' levels at the time of colorectal cancer diagnosis increase the risk of recurrence and death.
Distress is a term that collectively refers to the physical, mental, and social suffering experienced by patients and their families due to cancer and its treatment. It commonly appears alongside depression and anxiety at the time of cancer diagnosis. Approximately 40% of cancer patients are known to experience severe distress.
The research team examined the correlation between distress at diagnosis and recurrence and mortality rates in 1,362 patients who were diagnosed with primary colorectal cancer and underwent curative surgery at Samsung Seoul Hospital Cancer Center between July 2014 and July 2021. Using the Distress Thermometer and checklist developed by the National Comprehensive Cancer Network (NCCN), patients self-assessed their distress scores (PRO). Based on the distress scores, patients were categorized into low (below 4 points), high (4 to 7 points), and very high (8 points or above) groups, and the correlation with colorectal cancer progression-free survival was analyzed.
The average distress score among the study participants was 5.1 points, significantly exceeding the NCCN's cautionary threshold of 4 points. Sixty-one percent of all patients fell into the 'high' distress category, and 15% were classified as 'very high.' This means that 7 out of 10 patients (76% scoring 4 or above) require distress management from the time of cancer diagnosis. This reconfirms that a cancer diagnosis is one of the most bewildering and challenging experiences a person can face in life.
When combining the number of recurrences and deaths, the harmful impact of distress at diagnosis became even clearer. The low distress group experienced 50 cases of recurrence or death per 1,000 person-years, the high group 67.3 cases, and the very high group 81.3 cases. The risk of disease recurrence or death increased in tandem with the level of distress at diagnosis. When statistically calculating relative risk using the low group as a baseline, the high group had a 28% higher risk, and the very high group had an 84% higher risk. Particularly in advanced colorectal cancer stage 4, the increase in risk due to distress at diagnosis was even steeper. The risk of recurrence or death rose by 26% in the high distress group and by 153% in the very high distress group compared to the low distress group.
Furthermore, in addition to emotional factors such as fear, sadness, and worry caused by the disease, socioeconomic issues following cancer treatment?such as insurance, finances, work, and childcare?were identified as major burdens weighing heavily on patients. The study found that the higher the distress, the more these hardships intensified.
Professor Kim Hee-cheol stated, "Although cancer treatment outcomes are gradually improving, patients newly diagnosed with cancer still experience significant fear of the disease, which causes considerable mental stress. Moreover, many patients are preoccupied not only with emotional issues but also with practical life problems such as workplace and child-rearing concerns, which can interfere with focusing on treatment." He emphasized, "It is necessary to assess the distress patients feel from the outset of diagnosis to understand how well their treatment environment is prepared and to alleviate this distress before treatment begins."
This study was recently published in the international authoritative journal in the field of surgery, Annals of Surgery (IF=13.787).
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